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Volume 3, Number 2—June 1997
Letter

Treatment of Exudative Pharyngitis

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To the Editor: The dispatch by Izurieta et al. (Emerg Infect Dis 1997;1:65-8) reporting exudative pharyngitis possibly due to Corynebacterium pseudodiphtheriticum was very interesting, especially with the resurgence of diphtheria in the former Soviet Union. However, I was somewhat surprised at the treatment received by the 4-year-old patient whose case is reported. Erythromycin is an effective antibiotic in diphtheria, but it is secondary in importance to diphtheria antitoxin.

The presence of a thick grayish white adherent pseudomembrane, adenopathy and cervical swelling, and low grade fever should certainly provoke a high index of suspicion of diphtheria, especially in a child who has not received pediatric immunization. The diagnosis of diphtheria is primarily made presumptively on clinical grounds and confirmed by the recovery of toxigenic Corynebacterium diphtheriae by the laboratory.

Antitoxin treatment cannot wait for laboratory confirmation. Prompt administration of antitoxin is important because diphtheria toxin binds rapidly and irreversibly to tissue sites. Delay in initiating antitoxin treatment is associated with increased incidence of myocarditis, paralysis, and death. Also, it would have been good practice to have placed this child in isolation until the diagnosis was established by the laboratory. The primary care physician in this case is indeed fortunate that the patient did not have diphtheria; the results could have been tragic.

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Paul D. Ellner

Author affiliation: Professor Emeritus of Microbiology and Pathology, Columbia University College of Physicians and Surgeons

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DOI: 10.3201/eid0302.970224

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Table of Contents – Volume 3, Number 2—June 1997

Page created: December 21, 2010
Page updated: December 21, 2010
Page reviewed: December 21, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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